From the Guidelines
A lumbar disc protrusion is a condition where the soft inner material of an intervertebral disc in the lower back bulges outward through a weakened or damaged part of the disc's outer layer, remaining contained within the outer fibers. This condition is often associated with age-related degeneration, poor posture, repetitive strain, or sudden trauma to the spine 1. When a disc protrudes, it can press against nearby spinal nerves, causing symptoms like lower back pain, sciatica, numbness, tingling, or weakness in the legs. The severity of symptoms depends on the size and location of the protrusion and whether it's compressing neural structures.
Key Characteristics of Lumbar Disc Protrusion
- The soft inner material of the disc bulges outward through a weakened or damaged part of the disc's outer layer
- The inner material remains contained within the outer fibers, distinguishing it from a herniation
- Often caused by age-related degeneration, poor posture, repetitive strain, or sudden trauma to the spine
- Can press against nearby spinal nerves, causing various symptoms
Diagnostic Approach
According to the American College of Physicians and the American Pain Society, for patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis, MRI (preferred) or CT is recommended for evaluation, especially if they are potential candidates for surgery or epidural steroid injection 1. However, clinicians should be aware that findings on MRI or CT can be nonspecific, and decisions should be based on the clinical correlation between symptoms and radiographic findings.
Management
Most lumbar disc protrusions can be managed conservatively with rest, physical therapy, and anti-inflammatory medications. Severe cases that don't respond to conservative treatment may require epidural steroid injections or, rarely, surgical intervention to remove the protruding disc material. The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1.
From the Research
Definition of Lumbar Disc Protrusion
- A lumbar disc protrusion is a condition where the disc material, either the nucleus pulposus or annulus fibrosis, is displaced beyond the intervertebral disc space 2.
- It is also referred to as a herniated lumbar disc, which occurs when the central disc material is displaced beyond the outer annulus, compressing the spinal nerve roots 3.
- Lumbar disc protrusion can be caused by injury, degeneration, or other factors, and can be classified into different types, including damage-herniation, degeneration-protrusion, and posterior vertebral osteochondrosis with disc protrusion 4.
Characteristics of Lumbar Disc Protrusion
- Lumbar disc protrusion can cause a range of symptoms, including lower back pain, neurological dysfunction, and buttock/leg pain 5.
- The condition can be diagnosed with a thorough history and physical examination, along with advanced imaging techniques 5.
- Treatment plans for lumbar disc protrusion are dictated by the corresponding patient symptoms and examination findings, with their imaging, and can include nonsurgical measures or surgery 5.
Types of Lumbar Disc Protrusion
- The damage-herniation type is characterized by soft herniation, and the capsule can easily be cut and the broken disc tissue blocks overflow or is easily removed 4.
- The degeneration-protrusion type is characterized by hard and tough protrusions, and the pathological process is caused by degeneration and proliferative reaction 4.
- The posterior vertebral osteochondrosis with disc protrusion type is characterized by deformity of the posterior vertebral body, osteochondral nodules, and intervertebral disc protrusion 4.